Diabetes

Diabetes occurs when there is too much glucose (sugar) in the blood. This happens either when our pancreas can not produce enough insulin or our body becomes less responsive to insulin.

Glucose is the main source of energy for our body. It is the most important fuel for our brain, except during prolonged starvation. Our muscles also prefer glucose during bursts of activity. The glucose in our blood stream comes from:
Our diets. Carbohydrate foods are converted into glucose by our body.
Our liver can also produce glucose from fat and protein when the glucose level in our blood is low to ensure our body does not run out of this important energy fuel.

Insulin is a hormone produced by the β cells of the pancreas. It has two jobs in the body.
To tell our body cells to take up glucose so that it can be used for energy.
To switch off glucose production in the liver.

For people without diabetes, insulin is able to maintain the blood glucose level in between the range between 4mmol/L and 8mmol/L.

Types of Diabetes

There are three types of diabetes:

• Type I diabetes. Also called insulin dependent diabetes. It is a result of the destruction more than 90% of the β cells of the pancreas by the body’s own immune system. There is virtually no insulin secretion. Treatment is by insulin injection. The age of onset of Type I diabetes most commonly occurs before a person turns 30 years old.
• Type II diabetes or Non Insulin Dependent Diabetes. Insulin secretion is sluggish and gradually deteriorates overtime. The body is also resistant to the effect of insulin. Treatment is by taking tablets.
• Diabetes of pregnancy. Pregnancy increases insulin requirement by two to three fold. This is caused by the high level of steroid hormones produced by the placenta which interferes with the action of insulin. The growing fetus also increases the mother’s need for insulin. Some women’s body can not produce enough insulin to keep up with this increased demand resulting in diabetes. It usually resolves after child birth.

Symptoms of Diabetes

Type I diabetes usually presents with typical symptoms of diabetes. Type II diabetes develops slowly over a period of time, therefore can be without the usual symptoms of diabetes. It is usually only recognized during a routine medical examination. Symptoms of diabetes include:

• Feeling thirsty.
• Frequent urination.
• Tiredness.
• Blurred vision.
• Frequent skin infections.
• In women with Type II diabetes, vaginal thrush is a common complaint.
• Weight loss (in Type I diabetes).
• Obesity (in Type II diabetes).
• Ketoacidosis casuing a loss of appetite, nausea and vomiting. The end result if untreated is dehydration, coma and death.

Complication of Diabetes

• Cardiovascular disease.
• Blindness.
• Kidney failure.
• Nerve damage.
• Frequent skin infections.
• Foot problems leading to amputation (a result of nerve damage and poor wound healing).

Many of the above mentioned complications are more likely to occur as a result of persistent high blood glucose level and/or high blood pressure. Keeping both the glucose level and blood pressure under control is the best defense and may even be able to halt the progression of some of these complications.

Medical Treatment

Diabetes can not be cured at present but it can be managed effectively with proper medications. Please discuss this with your family doctor.

Self Help

Diet. Reduce sugar in your diet. Eat foods with low glycaemic index e.g. complex carbohydrates such as oats, grains, legumes (such as beans, lentils and peas) and less of white bread, potatoes and sugary breakfast cereals. Glycaemic index is a ranking of carbohydrates from 1 to 100 on how quickly they can elevate blood glucose level after a meal. Complex carbohydrates that breaks down gradually release glucose into the blood stream slowly have a low glycaemic index. They will also help to prevent the sudden highs and sudden lows in blood glucose level. Reducing saturated fat and salt in the diet will also help to prevent secondary complications such as cardiovascular disease.

1) Enjoy three meals a day, selecting from dishes that encourage you to eat plant foods and fish, with little or no dairy fat, meat fat or deep fried foods.
2) Choose fruits and/or vegetables at every meal and most snacks.
3) Select whole grains, whole grain breads, or high fibre breakfast cereals in place of white bread and low fibre varieties at most meals and snacks.
4) Include fish, or dried peas, beans and soy products, or a small serving of lean meat or skinned poultry, at one or two meals each day.
5) Choose low fat milk, low fat milk products, soy or legume products every day.
6) Use small amounts of oil, margarine, nuts or seeds.
7) Drink plenty of fluids each day, particularly water, and limit sugar-sweetened drinks and alcohol.
8) Use only small amounts of total fats and oils, sugar and salt when cooking and preparing meals, snacks, or drinks. Choose ready-prepared foods low in these ingredients.
9) Mostly avoid or rarely include butter, deep-fried and fatty foods, and only occasionally choose sweet bakery products.
The New Zealand Heart Foundation’s Nine steps to eating for a healthy heart

Lose weight. Obesity worsens resistance to insulin. Regular exercise encourages the body to respond to insulin. Aim to be physically active for at least thirty minutes a day. Walking after dinner in the evening is a good safe exercise. While exercising, be sure to take some precautions:

• Exercise about an hour after a meal, not before.
• Wear a medic alert bracelet stating that you have diabetes.
• Bring along something to drink.
• Bring along a snack that will get sugar quickly into your blood in the event of experiencing low blood sugar, e.g. jelly beans. Some signs of low blood sugar are: weakness, shakiness, sweaty, increased heart rate, tingling around mouth and tongue.
• Take good care of your feet. Buy a pair of comfortable and well made shoes. If you get a sore spot that does not heal, see a doctor.

Quit smoking. Nicotine narrow the blood vessels, which increases the risk of circulation problems such as heart attacks, strokes and leg ulcers. There are effective over the counter medications such as Nicorette and Nicobrevin to assist with smoking cessation. Alternatively call the toll free QUITLINE 0800 778 778 for advice.

• Eye care. Diabetes can cause damage to the blood vessels at the back of the eyes. Therefore it is very important that to have regular eye checks by a specialist.
• Feet care. Diabetes affects blood supply and damages nerves to the feet. It is very important to check your feet every day for cracks and cuts. See a doctor if there is a sore that is slow to heal.
• Take your diabetic medications at the same time everyday to help to control blood glucose level.
• Thompson’s Glucose Manager may be a useful health supplement. It is designed to help control blood glucose level and also prevent damage to the nerves of our feet.

Fo further information, please visit:

Diabetes New Zealand www.diabetes.org.nz

University of Sydney Glycaemic Index www.glycemicindex.com

New Zealand Dietetic Association www.dietitians.org.nz

Disclaimer: This information is intended for New Zealand residents and is of a general nature only. No person should act in reliance on any statement contained in the information provided and at all times should obtain specific advice from a health professional. To the extent permitted by law, ibuy pharmacy, their employees and agents accept no liability (even if negligent) for any injury, loss or damage caused by reliance on any part of this information. All rights reserved. In particular no alterations, additions or adaptions of this publication are permitted without written consent of ibuy pharmacy.